E-cigarettes are the hot tobacco control topic in 2014 and articles about them can be found every day in health news columns. Experts debate the potential dangers and benefits of e-cigarettes, and the differing viewpoints are sometimes heated (though not combustible). Some say e-cigarettes are much less harmful than traditional cigarettes and smokers should be encouraged to switch, or even dual use, if that helps them cut back. The New York Times reported this week that a new study in England found that smokers trying to quit were substantially more likely to succeed if they used electronic cigarettes than over-the-counter therapies such as nicotine patches or gum. Last week, however, a different study was published in the American Heart Association journal Circulation that indicated e-cigarette use is associated with significantly lower odds of quitting smoking. All agree that much more research is needed.

Overall, the complaints about and precautions against e-cigarettes from public health and advocacy organizations far outweigh their support. And for good reason. E-cigarettes could serve as a gateway drug for youth, re-normalize cigarette smoking in public perception, and discourage or delay tobacco cessation. Click HERE for Partnership for Prevention’s new position statement on e-cigarettes which outlines other reasons for concern.

With e-cigarette experimentation and regular use skyrocketing among youth, Big Tobacco’s billion dollar marketing machine is reaping success. Teens see the products advertised on TV and social media and then can purchase them easily online. All of this leads to a simple conclusion – the Food and Drug Administration must move swiftly to regulate e-cigarettes, finalizing the rule it proposed in April of this year. Only this action will ensure the needed health warnings, age restrictions for sales, and truth in advertising on a national scale.

The Campaign for Tobacco-Free Kids released a study this week confirming that gaps exist in tobacco cessation coverage provided by many insurance companies and many consumers lack full access to tobacco cessation therapies as required by the Affordable Care Act (ACA).

The ACA requires that insurers and employers cover all A and B grade preventive services recommended by the U.S. Preventive Services Task Force (USPSTF). The USPSTF recommends clinicians ask all adult patients about their tobacco use and provide behavioral counseling and pharmacotherapy to those that use tobacco. The USPSTF’s tobacco cessation recommendation received an A grade, indicating there is high certainty of a substantial benefit from delivering the service, and is therefore required to be covered with no cost-sharing.

Researchers at Georgetown University’s Health Policy Institute analyzed thirty-nine insurance contracts across six states for their compliance with the ACA. Significant variation was found in how tobacco cessation was covered in those contracts. The research found that:

• Tobacco cessation did not appear to be covered at all in some contracts.
• Other contracts contained conflicting provisions that made it difficult to determine tobacco cessation treatment was covered or the scope of the benefit.
• Some contracts were unclear on the terms of cost-sharing or were ambiguous about potential restrictions to accessing covered treatment.
• Many contracts did not cover pharmacotherapy (either prescription or over-the-counter).
• None of the 39 analyzed contracts (1) clearly stated that tobacco cessation treatment was covered, (2) provided coverage for individual, group, and phone counseling and FDA-approved cessation medication, (3) provided treatment by in-network providers with no-cost sharing, and (4) provided access to treatment with prerequisites (e.g., medical necessity or a health risk assessment).
• Only four (of 39) contracts covered individual, group, and phone counseling, and both prescription and over-the-counter medications.

In short, the report questions whether effective tobacco cessation services are actually available to consumers as required by the ACA. The confusing and ambiguous language contained in many insurance contracts makes it difficult for consumers to know what is covered, how to access treatment, and whether there is cost-sharing.

Insurance coverage of tobacco cessation treatment is crucial to reducing prevalence of tobacco use in the U.S. Evidence-based studies, such as The Return on Investment of a Medicaid Tobacco Cessation Program in Massachusetts (funded by Partnership for Prevention) and referenced in the Georgetown report, conclude that tobacco cessation services not only saves lives but are also cost effective. Every $1 invested in the Massachusetts Medicaid Tobacco Cessation Program led to average savings of $3.12 in cardiovascular-related hospitalization expenditures. Thus, a net return on investment of $2.12 was realized and on average these savings were recouped within slightly more than a year after the benefits were used.

To combat tobacco use in our nation we must uphold the ACA’s preventive services coverage requirements in a manner that is accessible and affordable to tobacco users. This will save lives and millions of dollars in tobacco-related health expenditures. In light of the increasing burden of healthcare on the U.S. economy, it would be irresponsible to do otherwise.

In most European nations, sexuality is embraced as a positive, natural part of life. There is open dialogue and positive social norms associated with sexual health and sexuality. In contrast, many Americans are uncomfortable talking about sex. While American girls most often initiate the conversation, they worry that their partners will react negatively, either rejecting them or questioning their sexual history. Most young adults report that they would postpone sexual activity if they could converse more openly and honestly with their parents. Meanwhile many parents say they don’t know how to talk to their kids about sex and tend to avoid the subject altogether. Teens and their healthcare providers also rarely talk about sex, with 66% of teens aged 15-17 saying they have never discussed condoms or birth control with their doctor.

However, an Advocates for Youth study found that parents in countries such as the Netherlands, Germany, and France accept that sexual behavior is a normal part of human development. In these countries, adults tend to have greater respect for adolescents while expecting them, in turn, to act responsibly. There is also strong government support for sexuality education, long-term public education campaigns, and access to sexual health care services, including contraception. It is easier for European families to engage in open and honest discussions with teens about sexuality and sexual health services. When sexual health and sexuality are positively discussed and addressed, the overall quality of life and health of society is improved.

Unfortunately, the U.S. lags behind most other western nations in achieving optimal sexual health. Rooted in our longstanding, conservative attitudes, our approach to sexual health and sexuality is often negative, focused on disease and risks, incomplete, and sensationalized. Many Americans also lack access to adequate sexual health education and health services. These factors have contributed to high levels of sexually transmitted infections and chronic illnesses, unintended pregnancies, infertility, discrimination, stigma and partner violence.

The U.S has made significant progress —the teen pregnancy rate has declined 42% since 1990 — but is still nearly three times greater than rates in France and Germany. Similarly, the 2008 U.S. teen birth rate was nearly two times greater than the United Kingdom and ten times greater than Switzerland’s. Not surprisingly, European youth are more likely to be well protected during their most recent sex than their U.S. peers, with significantly higher levels of condom and contraceptive pill use. These teenage trends continue into adulthood. The prevalence of HIV among the adult U.S. population is estimated to be 1.5 to 6 times higher than France, Germany and the Netherlands.

Americans of all ages often lack the information and skills they need to make good sexual decisions. Surveys reveal that many are misinformed about the risks of unprotected sex, particularly the risks of oral sex; the availability and effectiveness of different contraceptives, along with how to use them; and their personal level of risk. Large-scale communications campaigns like Bedsider from the National Campaign to Prevent Teen and Unplanned Pregnancy, which focuses on increasing contraceptive usage and consistency, have begun to address this need. However, there is much more to do. We can also learn from models around the world, such as the “Sex Worth Talking About” campaign in the United Kingdom, which aims to transform the prevailing culture of “stigma shame, and embarrassment” into a “new culture: open, positive, supportive, respectful.”

Good health is important to achieve and maintain throughout life, and this includes our sexual health. We must embrace sexual health and sexuality as a natural, normal, and positive part of life, across the lifespan and in a variety of contexts. Beginning to have open and honest communication and dialogue on the subject is a step in the right direction. We need to make “sexual health” a household term, from the dinner table to the doctor’s office.